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Combined analysis of clinical features, human chorionic gonadotropin (hCG) value, and hCG ratios for early prediction of postmolar gestational trophoblastic neoplasia

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate factors predicting postmolar gestational trophoblastic neoplasia (GTN) by combined analysis of clinical features, human chorionic gonadotropin (hCG) value, and hCG ratios.

Methods

This retrospective study enrolled patients with histopathologically proven molar pregnancy. Patients lost to follow-up before remission or developing postmolar GTN were excluded. Demographic and clinical characteristics and hCG data obtained before and after molar evacuation were collected. Area under the receiver operating characteristic curve (AUC) analysis was used to identify the hCG and hCG ratio cutoff values that predict postmolar GTN. Multivariate analysis was employed to identify independent predictors of GTN.

Results

There were 113 complete moles, 11 partial moles, and 52 unspecified moles included in the final analysis. Of the 176 cases, 90 achieved remission and 86 developed post-molar GTN. The incidence of postmolar GTN was 48.9%, with a median time to GTN development of 5 weeks. Univariate analysis showed age, molar evacuation performed elsewhere, pre-evacuation hCG, hCG at 2nd week post-evacuation, and ratio of hCG at 2nd week post-evacuation to post-evacuation hCG significantly predict GTN. Multivariate analysis revealed an hCG value ≥ 1400 IU/L at 2nd week post-evacuation (AUC: 0.92, aOR: 6.51, 95% CI 1.28–33.16; p = 0.024) and a ratio of hCG at 2nd week post-evacuation to post-evacuation hCG of ≥ 0.02 (AUC: 0.88, aOR: 12.27, 95% CI 2.15–70.13; p = 0.005) to independently predict GTN.

Conclusions

An hCG value ≥ 1400 IU/L at 2nd week post-evacuation and a ratio of hCG at 2nd week post-evacuation to post-evacuation hCG of ≥ 0.02 independently and reliably predict postmolar GTN.

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Acknowledgements

The authors gratefully acknowledge Miss Julaporn Pooliam for assistance with statistical analysis.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Chanya Rakprasit

  2. Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Irene Ruengkhachorn, Suwanit Therasakvichya, Perapong Inthasorn, Vuthinun Achariyapota, Sompop Kuljarasnont, Khemanat Khemworapong & Nida Jareemit

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  1. Chanya Rakprasit
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Contributions

CR: conceptualization, methodology, data collection, and writing (original draft); IR: writing (review and editing); ST: writing (review and editing); PI: writing (review and editing); VA: writing (review and editing); SK: writing (review and editing); KK: writing (review and editing); and, NJ: conceptualization, protocol development, methodology, data analysis, and writing (original draft, review, and editing). All authors have reviewed and are in agreement with the version of the manuscript submitted for journal publication.

Corresponding author

Correspondence to Nida Jareemit.

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Conflict of interest

All authors declare no personal or professional conflicts of interest, and no financial support from the companies that produce and/or distribute the drugs, devices, or materials described in this report.

Ethical approval

The study protocol was approved by the Siriraj Institutional Review Board (SIRB) of the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (COA No. Si 167/2021).

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Consent statement is not applicable for this retrospective study.

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Rakprasit, C., Ruengkhachorn, I., Therasakvichya, S. et al. Combined analysis of clinical features, human chorionic gonadotropin (hCG) value, and hCG ratios for early prediction of postmolar gestational trophoblastic neoplasia. Arch Gynecol Obstet 307, 1145–1154 (2023). https://doi.org/10.1007/s00404-022-06785-w

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